Provider Demographics
NPI:1871054478
Name:BOUCAS, PETER (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BOUCAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:3030 W SALT CREEK LN STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5006
Practice Address - Country:US
Practice Address - Phone:847-870-4200
Practice Address - Fax:847-870-0059
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036175068207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery